Top 5 Fridays! 5 #PTProblems | Modern Manual Therapy Blog

Top 5 Fridays! 5 #PTProblems

There are certain aspects of our profession that honestly have me scratching my head, or banging it against a wall. Here are 5 of them

1) Early patients

  • they come 15-20 minutes early and say something like "Can I hop on the bike?" or "How about some heat while I wait?"
  • SERIOUSLY? Do you just walk in to your hair stylist and ask to start washing your hair before your appointment time?
  • At your dentist, do you walk right past the secretary, sit in a chair and start brushing your teeth yourself?
2) Late patients
  • In my experience, calling and saying you're going to be
    • 5 minutes late = 10 minutes late
    • 10 minutes late = 15 minutes late
    • 15 minutes late = please reschedule, you just missed 50% of your appointment
  • do people do this for their dentist, stylist, or restaurant reservations? No... they try to make it on time, and expect NOT to be taken after a certain amount of time
  • why are we de-valued?
  • I'm sure it is perpetuated by those clinics seeing 4 people an hour per PT, if you get no 1:1 time, I'm sure appointment times are mere suggestions rather than something you have to keep
3) Maintenance Adjustments
  • Patients are so convinced that maintenance adjustments are making them better, keeping them aligned, etc...
  • to me, a biweekly adjustment and/or even worse, a monthly adjustment, is like working out once every other week or monthly and saying you're losing weight or getting stronger
4) I tried PT and it didn't work
  • do people say, "I tried restaurant and the food was bad, so I'm never eating out again!"
  • of course not, but apparently all PT is the same
  • the frustrating thing about being a better clinician is the other ones out there are ruining it for you! 
5) Intra-professional fighting or reducing different approaches
  • we don't need the DPT, or new grads not being allowed to call themselves "doctor" in the clinic
    • well, it's here to stay, get used to it
  • MDT is only prone pressups
    • If McKenzie stopped when the OMPT world criticized him, thousands upon thousands of patients would be left with passive treatments and most likely not better
  • Rocabado is just 6x6 exercise program
    • don't get me started on this
  • who needs dry needling?
    • people who improve from it
  • You don't need a big toolbox
    • I don't know about you, but the whole movement toward clinical decision making vs better toolbox is pretty myopic, it's not "VS"  
    • why not have both, it's the best of both worlds!
    • if somehow you can rely on putting all of your eggs in 1-2 baskets you're a better clinician than most
    • I certainly use much less "technique" than I was originally trained with, but to say that you don't need a bigger toolbox is short sighted, especially when you've only been out a few years
  • we all get patients better regardless of our assessment, training, and interactions, but there are patients who will not respond to your tried and true and you WILL need a different way to look at things, explain things, or treatment to get improvements to stick
Anything that you consider #PTProblems unique to our profession?


  1. Erson, i thought these problems were just here in Brazil. It's a relief but things to be concerned.

  2. Lisandro, you're right! It is both a relief and a concern that it seems to be everywhere!

  3. You missed one more thing..... Maitland = only grades of mobilization :) (atleast here in INDIA)

  4. As in an order for Maitland without the understanding that it's a system?

  5. Barbara J. CarusilloAugust 18, 2013 at 10:03 PM

    I am not aware of a new thinking of better decision making versus bigger tool box. What is that about? I mean, duh, of course we need both. I sometimes think, after 34 years in the field, that I wish I could go back to knowing fewer techniques to get folks better, (life would be simpler), but I have found the more I learn, the more I find out there that I didn't know before. And each course I go to, I learn something that actually helps a certain percentage of patients that I didn't know before. I think the bigger the bag of tricks to try along with good clinical decision making is always advantageous...

  6. I want to say that your blogs are awesome :) ......
    I feel so bad to have come across it so late.......

  7. What's late? I'm not stopping so just keep reading and please share! Thanks!

  8. You'd think that yes, but there are those out there that seem to think advanced clinical reasoning trumps a toolbox. As if there is an option for one or the other.